To the Editor: The study by Dr Tricoci and colleagues1 underlined the difference between the reality of clinical work (which is extremely complex and cannot easily be reduced to simple standardized procedures) and clinical practice guidelines. These guidelines are intended to cover clinical reality as far as possible. However, the broader the reality, the less precise the guidelines become. From 1984 to 2008, the number of recommendations increased from 1330 to 1973 (a 48% increase), but only 11% of these recommendations were classified as level of evidence A, with 48% classified as level of evidence C.
Enia F. Clinical Practice Guidelines and Scientific Evidence. JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.910